Provider Demographics
NPI:1952953168
Name:HART, ATHENA NOEL (LMSW)
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:NOEL
Last Name:HART
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ATHENA
Other - Middle Name:NOEL
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:5007 S GRAN TERA DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-1586
Mailing Address - Country:US
Mailing Address - Phone:626-862-3956
Mailing Address - Fax:
Practice Address - Street 1:6301 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-1586
Practice Address - Country:US
Practice Address - Phone:520-792-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-15928104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker